Nutritional Counseling Pocket Guide

Fast Facts

Nutrition is a key determinant in 3 of the top 4 U.S. causes of death — heart disease, stroke, and cancer.
Nutrition is a key component of most chronic conditions primary care clinicians treat: diabetes, obesity, high blood pressure, and high cholesterol.

One survey of 451 family physicians found that 58 percent believed that most of their patients would benefit from nutrition counseling.

What is Nutritional Counseling?

A nutrition counselor talks with a patient about his or her diet and finds ways to change it to support that person’s health. A nutrition consult typically begins with a one-hour evaluation to assess the patient and the patient’s diet. The nutritionist may also assess sleep patterns, physical activity, and other lifestyle factors.

With this information, the nutritionist works with the patient to identify opportunities for change. This does not always mean starting a low calorie diet. It could mean picking one thing to change, such as drinking less soda or eating more protein. Changing even one thing can have a big impact on health and healing.

Planning comes next. For instance, a nutrition counselor can help people find ways to eat healthy without spending a lot of money, or how to choose healthy options when eating out. With cancer or another disease, the nutritionist helps the patient get necessary nutrients and stay as healthy as possible during and after treatment.

What does the science show?

Numerous studies find that improving diet can provide the same, if not better, benefits than medical therapy with less risk, fewer side effects, lower costs, and shorter hospital stays. Most major medical guidelines include nutrition as a key part of managing chronic disease. This includes guidelines on nutrition in cancer treatment and for survivors, such as the ESPEN guidelines. ¹ The U.S. Preventive Services Task Force found good evidence that dietary counseling for patients with risk factors for heart disease can improve eating habits, particularly if delivered by nutritionists, dietitians, and specially trained primary health care professionals. ² Similar studies have shown benefits for diabetes, ³ obesity, ⁴ and hypertension.

Is it OK to follow the latest diet trends?

Don’t be fooled by fad diets. Professionals know that the best diets to follow for general health are variations of the Mediterranean and DASH diets. People with cancer should talk to a nutrition counselor about the best choices, as they need more protein and fat than people practicing “healthy eating” in order to avoid losing muscle and weight during treatment. ⁵ Extreme diet changes can harm you — both physically and mentally. Losing weight and gaining it back many times is bad for health and makes permanent weight loss more difficult.

Who can benefit from nutrition counseling?

Nutrition counseling is used to treat many different health conditions. These include:

Obesity
Diabetes/Pre-Diabetes
Digestive Problems
Eating Disorders
Metabolic-associated liver disease (MASLD)
Food allergies and sensitivities
Heart disease, high cholesterol, and high blood pressure
Obesity
Polycystic ovary syndrome (PCOS)

Nutrition counseling can also help people who have HIV, COPD (chronic obstructive pulmonary disease), and other conditions, and is part of treatment for eating disorders.

How do I find a qualified nutrition counselor?

Check to see if the nutrition counselor is licensed or certified to practice. The main professional organization is the Academy of Nutrition and Dietetics. It provides a search by ZIP Code on their website of qualified practitioners.

Look for a registered dietitian (RD) or registered dietitian nutritionist (RDN). Earning these credentials means someone has a 4-year college degree, plus 900 to 1,200 hours as an intern in an accredited program. He or she has also passed a dietetics registration exam and meets continuing professional education requirements. Some RDNs are certified in a specialty, such as cancer, children’s nutrition, sports, or diabetes education.

Some RDNs are certified in a specialty, such as cancer, children’s nutrition, sports, or diabetes education.

Does insurance cover it?

Most insurance plans, including Medicare and Medicaid, cover medical nutrition therapy (MNT) for certain conditions, including diabetes. Obesity screening and counseling are covered if they are received in a primary care setting. Medicare recipients in rural areas may receive MNT through telehealth. Insurance may cover other types of nutrition counseling. Patients should check their insurance benefits or contact the insurance company to learn what is covered.

Is nutrition counseling safe?

Seeing an RD or RDN is considered safe since their qualifications are highly regulated at the state and government level. Patients should ask about any possible discomfort or changes to expect with a new eating plan, such as gas when adjusting to eating more fruits and vegetables. People being treated for cancer or any other specific medical condition should make sure the RD or RDN knows all the medications you take and treatments you receive.

Contact the counselor or primary care doctor with any questions or concerns.

Should I tell my primary care provider that I am receiving nutrition counseling?

Yes. Always tell your primary care provider about all the other providers you see. Especially if you have cancer or another serious condition, make sure all your providers know about each other and are working together.

Resources for Patients

Cook for Your Life. Fred Hutch Cancer Center
Find a Nutrition Expert. Academy of Nutrition and Dietetics. Also includes a large amount of free information on foods, conditions, and nutrition science.
Nutrition for People with Cancer. American Cancer Society.

Resources for Providers

Campbell TM. An Approach to Nutritional Counseling for Family Physicians: Focusing on Food Choice, Eating Structure, and Food Volume. J Fam Pract. 2022 Jan;71(Suppl 1 Lifestyle):eS117-eS123. Available as a free PDF from the American College of Lifestyle Medicine at www.lifestylemedicine.org.
Nutrition in Cancer Care (PDQ – Health Professional Version). National Cancer Institute.

References

Olendzki B, Speed C, Domino FJ. Nutritional assessment and counseling for prevention and treatment of cardiovascular disease. Am Fam Physician. 2006 Jan
15;73(2):257-64.
Diabetes Prevention Program Research G, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677-1686.
Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. The American Journal of Clinical Nutrition. 2001;74(5):579-584.
Aprile G, Basile D, Giaretta R, et al. The clinical value of nutritional care before and during active cancer treatment. Nutrients. 2021 Apr 5;13(4):1196.
Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021 May;40(5):2898-2913.

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